When nobody has explained why

What functional medicine actually means

The term gets used loosely, so here is what I mean by it. Conventional medicine is very good at naming a disease and matching it to a treatment. That works well for a heart attack or a fracture. It works less well for the person who is exhausted, bloated and foggy, whose blood tests are unremarkable, and who does not fit a diagnostic box.

Functional medicine starts from the mechanism instead of the label. Why is this person's system behaving this way? Usually several things are contributing at once, and the combination differs between two people who arrive with identical symptoms. The work is identifying which factors are active in you, and addressing those.

It is not an alternative to conventional medicine, and I have not left conventional medicine to practise it. It is a different set of questions asked of the same biology.

The two are not separate things

I describe this as functional medicine because that is what people search for and how the field is usually named. It is not quite how I think about it. What I actually do is integrate conventional medical training with functional medicine tools - and the integration is the point, not the label.

In practice that means the same consultation draws on both: hospital medicine to recognise disease, exclude the serious, read investigations properly and know when something needs a specialist; functional medicine to ask why a system is behaving this way, and to test and treat accordingly. Neither half does the job alone. A functional medicine practitioner without medical training will miss things that matter, and a conventional consultation rarely has the time or the framework to look for mechanisms.

What the evidence does and does not show

You are entitled to be sceptical, and I would rather address it than avoid it.

The model as a whole has limited trial evidence.Functional medicine is a way of organising care around the individual, which makes it hard to test in the randomised trials that settle most questions in medicine. The largest study to date, from the Cleveland Clinic in 2019, followed around 1,600 patients and found larger gains in health-related quality of life at six months than in patients seen in primary care. It was observational: patients chose which service to use, and that cannot rule out the difference being in who chose it.

Many of the individual tools rest on firmer ground.Correcting deficiencies, dietary change for irritable bowel syndrome, treating insulin resistance, structured exercise, and treating poor sleep and sleep apnoea are all supported by randomised trials and, in several cases, by NICE guidance. Most of what I recommend first comes from that end of the evidence, because it is the most likely to help.

Some tests and treatments in the field are not well validated, and I say so when they come up. Some I do not use at all - the tick-borne illness guide names several. Where I do use something with weaker evidence, I tell you, and I explain why I think it is worth it in your case.

And I measure. Symptoms, blood results and, where it applies, standard scores are recorded at the start and repeated, so that we can both see whether the plan is working rather than assume it.

What I do not do

I do not treat serious disease that belongs in a hospital, and I will say so plainly if that is what your history suggests. I do not offer naturopathy or herbal medicine as standalone services - where botanical or nutritional treatment is appropriate it forms part of a wider plan, not the plan itself. And I do not sell supplements as the answer to everything.